SHA

DAC
S TATE H EALTH A CCESS

D ATA A SSISTANCE C ENTER

April 2003/Issue 6

A Health Data Resource for States

A Comparison of Childrens
Uninsurance Rates Across the
States: 1995-96 to 2ooo-o1


In the mid nineties, the rates of uninsured
children climbed following the enactment of
welfare reform, as many previously insured
children became ineligible for Medicaid.1 In
1997, the State Childrens Health Insurance
Program (SCHIP) was enacted as Title XXI
of the Social Security Act. From 1997 to
2000, all states developed and implemented
programs under SCHIP. Many of these
states, such as Tennessee and Missouri,
have made significant efforts to identify
and insure children who are not covered by
a health insurance plan. During that same
period, employer-sponsored coverage grew
slightly for the population as a whole2 but
decreased for children.3 Despite this
decrease in private coverage, the Current
Population Surveys (CPS) two-year average

uninsurance estimates show that more

American children had health insurance
coverage in 2000-01 than in 1995-96.
In 2001, approximately 8.5 million children
did not have health insurance, down from
over 10 million in 1996. Here, we assess the
changes in health insurance coverage among
children across the states for the five-year
time period spanning Welfare Reform and
the enactment and implementation of
SCHIP. Estimates used for all comparisons
between 1995 and 2001 are adjusted for the
verification question added to the CPS
health insurance module in 20004,5. With
the exception of Figure 1, we use 2-year
averages for 1995-96 and 2000-01. For
observations pertaining only to 2000-01
(Table 2), we used verified data.

Figure 1: National Childrens Uninsurance Rates Between 1995 and 2001

20
18
16

University of Minnesota
School of Public Health
Sponsored by a grant
from The Robert Wood
Johnson Foundation.

14.8

Percent of
Uninsured 14
Children

15.0

15.4

SCHIP
Implementation (2)
13.9

13.8

13.4
12.8

Welfare
Reform (1)

12
10
~
~

0
1995

1996

1997

1998

Source: Historic Health Insurance Tables. March Supplement 2001 CPS

1999

2000

2001

Figure 2:

AK
2.2%

Figure 2: Percent Point Change in Two-Year Averages of

PercentRates
Point
Change1995-96
in Two-Year
Averages
Uninsurance
for Children:
to 2000-2001

of Uninsurance Rates for Children: 1995-96

to 2000-2001
WA
2.0%

ND
2.1%

MT
3.9%

OR
-1.7%

MN
-0.3%

SD
1.0%

ID
1.1%

WY
0.3%

NV
-3.5%

UT
0.1%

NE
-1.1%

WI
-1.4%

IL

CO
-1.1%

KS
0.1%

CA
-1.2%

MI

NY

-0.4%

-1.9%

OK
-3.9%

NM
-3.0%

OH

1.5%

0.2%

RI
CT -4.5%
NJ

VA
-0.0%

DE
-3.3%

MD
0.6%

NC

TN -9.5%

-2.1%

-4.1%

2.0%

KY

-3.6%

DC
-4.7%

SC
MS
-8.5%

TX
-0.2%

MA

0.5%

WV

MO
-6.2%
AR
-6.0%

ME

-1.5%

PA
IN

-4.8%

AZ
-5.0%

NH
0.5%

-6.7%

IA
-3.6%
3.0%

VT
-2.9%

-7.6%

AL

GA

-3.0%

-1.3%

LA
-6.5%

Percent Point Change

Increase
No Change

HI
4.6%

FL

Decrease

-0.5%

Decrease
(Significant)

No state experienced a statistically significant increase (at a significance level of p<0.1) in the
number of uninsured children during this time period.

Changes in the Number of Uninsured Children

from 1995-96 to 2ooo-o1
Although an important catalyst, SCHIP was only one
factor in the increase in coverage. SCHIP outreach efforts
led to an increase in Medicaid enrollment,6 and the
economy at this time was experiencing robust growth.
These were also important contributions to the decrease
in uninsured children.7

Variation in Percent Change Across States

In general, states with the lowest uninsurance rates for
children in 1995-96 retain the lowest rates in 20002001. In addition, many of the states with the highest
uninsurance rates in 1995-96 were among those with the

most noticeable decreases in uninsured children over the

five-year period. Tennessee led the nation with the
largest decrease in the number of uninsured children
from 1995-96 to 2000-01, reducing the child uninsurance
rate by approximately 10% over five years.
A few states have shown little or no improvement. The
chart below shows that only five states made statistically
significant decreases in their rates of uninsured children.
In 2000-01, one in five children in Texas remained
uninsured, and in Arizona, New Mexico, and California,
approximately one in six children had no health coverage.
An additional ten states that did not have significant
decreases in their rates of uninsured children remain
above the national average.

Figure 3: Two-Year
Average Uninsurance Rates for Children 1995-96 to 2001-01

State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi*
Missouri**

Rate of
Uninsured
Children
1995-96
(2-yr avg.)
12.9
11.1
22.5
19.2
17.6
16.1
10.4
13.4
16.3
18.3
15.0
6.1
13.0
9.6
11.5
10.9
10.7
15.7
21.3
14.5
10.5
8.8
7.9
6.9
19.2
13.1

Rate of
Percent
Uninsured Point Change
Children
Between
2000-01
1995-96 &
(2-yr avg.)
2000-01

9.8
13.3
17.5
13.2
16.4
14.9
8.3
10.1
11.6
17.8
13.6
10.7
14.1
12.6
12.9
7.3
10.8
10.9
14.8
7.8
11.1
7.3
7.5
6.5
10.7
6.9

-3.0
2.2
-5.0
-6.0
-1.2
-1.1
-2.1
-3.3
-4.7
-0.5
-1.3
4.6
1.1
3.0
1.5
-3.6
0.1
-4.8
-6.5
-6.7
0.6
-1.5
-.04
-0.3
-8.5
-6.2

Rate of
Uninsured
Children
1995-96
(2-yr avg.)

State
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York**
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina**
South Dakota
Tennessee***
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
U.S.***

Rate of
Percent
Uninsured Point Change
Children
Between
2000-01
1995-96 &
(2-yr avg.)
2000-01

10.5
9.2
19.9
7.6
15.3
20.6
13.5
15.1
8.2
9.8
20.9
13.9
8.1
9.4
17.9
8.3
16.8
23.5
10.6
7.9
10.7
9.9
8.4
6.5
12.6
14.3

14.4
8.1
16.4
8.1
11.2
17.6
11.6
11.5
10.3
9.9
16.9
12.2
8.6
4.9
10.3
9.2
7.3
23.3
10.6
4.9
10.7
11.9
10.4
5.1
12.9
13.1

3.9
-1.1
-3.5
0.5
-4.1
-3.0
-1.9
-3.6
2.1
0.2
-3.9
-1.7
0.5
-4.5
-7.6
1.0
-9.5
-0.2
0.1
-2.9
0.0
2.0
2.0
-1.4
0.3
-1.2

Asterisks correspond to the following significance levels: *p=0.1, **p=0.05, ***p=0.01. Results without asterisks are not significant.
Source: 1995-1996 and 2000-2001 Historic Health Insurance Tables and March Supplement 2002 CPS.

Distribution of Uninsured Children

Uninsurance among children varies a great deal across
the states, with the highest rates concentrated in the
Southwest region. Over forty percent of all the uninsured
children in the U.S. live in three states-California,
Texas, and Florida, while only twenty-eight percent of
all the nations children live in these states. By contrast,
the large number of uninsured children in New York
and Illinois is a function of the large total populations
of children in those states, not of high uninsurance
rates. Nine percent of the nations uninsured children
live in New York and Illinois, but eleven percent of all
of the children in the country reside in these two states.

Figure 4: Distribution of Uninsured

Children Across States in 2ooo-01
Highest Numbers of Uninsured Children
State

Number of
Uninsured
Children

California

1,466,500

17.13

Texas

1,358,500

15.86

Florida

643,000

7.51

New York

462,000

5.34

Illinois

328,000

3.84

4,207,000

49.68

Total
Highest 5

Percent of Total
Uninsured
Children in U.S.

Source: Historic Health Insurance Tables. March Supplement 2001 CPS

SHA

DAC
S TATE H EALTH A CCESS

D ATA A SSISTANCE C ENTER

Conclusions
With increased federal flexibility, states
been able to tailor SCHIP and Medicaid
programs to their specific needs. However,
this flexibility in the use and design of the
programs has made comparative analysis
more difficult. Nonetheless, monitoring
trends at the state level is critical to understanding the changing dynamics of health
insurance coverage.

This preliminary assessment shows a marked

decrease in the uninsurance rates for children
following the implementation of SCHIP.
While this analysis did not control for local
environment and other effects, it is evident
that many states had great success in lowering
their childrens uninsurance rate over this
five-year period. These accomplishments are
encouraging and should be closely watched to
monitor the effects of changes in the trend
over time.

Notes
1

Guyer, Jocelyn. Uninsured Rate of Poor Children Declines but Remains Above Pre-welfare Reform
Levels. Center on Budget and Policy Priorities 2000. Washington, DC. http://www.cbpp.org.

Holahan, John; Pohl, Mary Beth. Changes in Insurance Coverage: 1994-2000 and Beyond. Health
Affairs Web Exclusive. April 3, 2002.

Cunningham, Peter J.; Reschovsky, James D.; Hadley, Jack. SCHIP, Medicaid Expansions Lead to
Shifts in Childrens Coverage. Center for Studying Health System Change. Issue Brief No. 59.
http://www.hschange.org/CONTENT/508/

All SCHIP statistics have been taken from SCHIP Annual Reports. Uninsurance rates, Medicaid rates,
and unemployment statistics have been taken from the CPS.

State Health Access Data Assistance Center (SHADAC) Issue Brief #4: What is Behind the 8 Percent
Drop in Uninsurance: Changes in CPS Health Insurance Measurement and the Effect on State Policy.

Centers for Medicare and Medicaid Services. The State Childrens Health Insurance Program Annual
Enrollment Report. Federal Fiscal Year 2001; October 1, 2000-September 20, 2001. February 6, 2002

Park, Michael H.: Cunningham, Peter J. Some Communities Make Progress in Reducing Childrens
Uninsurance. Center for Studying Health System Change 2000. Data Bulletin No. 19.
http://www.hschange.org

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Division of Health Services
Research and Policy
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Phone 612-624-4802
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